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Layton TB, Williams L, Nanchahal J. Dupuytren's disease: a localised and accessible human fibrotic disorder. Trends Mol Med 2023; 29:218-227. [PMID: 36566101 DOI: 10.1016/j.molmed.2022.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
We review the biology of Dupuytren's disease (DD), a common localised fibrotic disorder of the hand. The disease develops through a complex interplay of genetic and environmental factors, and epigenetic signalling. The early-stage disease nodules comprise a complex milieu of stromal and immune cells which interact to promote disease development. Recently, inhibition of tumour necrosis factor (TNF) locally resulted in softening and a decrease in nodule size, potentially controlling disease progression. Unlike fibrotic disorders of the visceral organs, the easy access to tissue in DD patients enables dissection of the cellular landscape and molecular signalling pathways. In addition, the study of DD may have wider benefits in enhancing our understanding of less-accessible fibrotic tissues.
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Affiliation(s)
- Thomas B Layton
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford OX3 8FE, UK
| | - Lynn Williams
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford OX3 8FE, UK
| | - Jagdeep Nanchahal
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford OX3 8FE, UK.
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Jump CM, Duke K, Malik RA, Charalambous CP. Frozen Shoulder: A Systematic Review of Cellular, Molecular, and Metabolic Findings. JBJS Rev 2021; 9:e19.00153. [PMID: 33512972 DOI: 10.2106/jbjs.rvw.19.00153] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Frozen shoulder is a common, poorly understood condition affecting the shoulder joint, with poor long-term outcomes in some in relation to pain and mobility. Understanding the pathophysiology of frozen shoulder at a cellular level and a molecular level may help in the development of novel treatments. The aim of this study was to perform a systematic review of studies examining the cellular, molecular, and metabolic findings in frozen shoulder. METHODS A literature search was conducted using Embase, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and PubMed using relevant terms. Studies were included if they assessed cellular, molecular, or metabolic alterations in tissue or blood samples of patients with frozen shoulder. RESULTS Of 4,794 studies identified, 25 were included for analysis. Histological findings included nonspecific chronic inflammation and the proliferation of fibroblasts, adipocytes, and blood vessels. Molecular studies showed increased pro-inflammatory mediators, reduced matrix metalloproteinases (MMPs), and increased activity of factors promoting fibroblast activation and nerve growth. Metabolic alterations included an increase in blood lipids. CONCLUSIONS Frozen shoulder is thought to occur after a primary insult to the shoulder triggers a complex cascade and upregulation of growth factors and cytokines with an increased turnover of the extracellular matrix, activation of myofibroblasts with deposition of collagen, and reduced matrix degradation. The presence of a background pro-inflammatory state (e.g., patients with diabetes or hyperlipidemia) may exacerbate these abnormalities. Further work assessing patients in early stages of the disease and comparing the inflammatory or fibrogenic characteristics of the shoulder capsule with those of the other joints may help to determine the initiating factors and to explain the predisposition of the shoulder to stiffness. CLINICAL RELEVANCE Our findings may form the basis for identifying new targets for the clinical management of frozen shoulder.
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Affiliation(s)
- Christopher M Jump
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Kathryn Duke
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | | | - Charalambos P Charalambous
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, United Kingdom.,School of Medicine, University of Central Lancashire, Preston, United Kingdom
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Abstract
Dupuytren disease causes nodules and thickened fascial cords in the hands of affected individuals. In this article, the author explains normal fascial anatomy of the hand and describes how it relates to the pathologic anatomy found in Dupuytren disease. Anatomic findings in diseased cords are described, with particular reference to dangers encountered in treatment of this condition.
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Affiliation(s)
- Stephen J Leibovic
- Department of Orthopedic Surgery and Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University, Richmond, VA 23298, USA; Virginia Hand Center, 2819 N. Parham Road, Suite 100, Richmond, VA 23294, USA.
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Seyhan H, Stromps JP, Demir E, Fuchs PC, Kopp J. Vitamin D deficiency may stimulate fibroblasts in Dupuytren's disease via mitochondrial increased reactive oxygen species through upregulating transforming growth factor-β1. Med Hypotheses 2018; 116:40-41. [PMID: 29857907 DOI: 10.1016/j.mehy.2018.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 04/11/2018] [Accepted: 04/16/2018] [Indexed: 01/05/2023]
Abstract
Dupuytren's disease, a benign fibroproliferative disorder of the palmar fascia, represents an ideal model to study tissue fibrosis. Transforming growth factor-β1 (TGF-β1) and its downstream Smad signaling system is well established as a keyplayer during fibrogenesis. Vitamin D has been extensively studied as an anti-fibrotic agent in malignant chronic diseases. A number of studies have shown that myofibroblasts are main target cells of 1,25(OH)2D3 inhibitory action. The myofibroblast in the palmar aponeurosis of patients in different stages of Dupuytren's disease was found by electron microscopy to contain a large number of mitochondria. Mitochondria play a critical role in cell metabolism being the major source of reactive oxygen species (ROS) in cells. TGF-β1 has been shown to increase mitochondrial ROS production in different cell types, which mediate fibrosis related gene expression and myofibroblast differentiation. TGF-β1 increases mitochondrial ROS production in patients with Dupuytren's contracture potentially in consequence of Vitamin D deficiency, leading to myofibroblast differentiation. Thus, targeting this basic pathomechanism seems suitable to establish new treatment strategies.
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Affiliation(s)
- Harun Seyhan
- Department of Plastic Surgery, Hand Surgery-Burn Center-University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Germany.
| | - Jan-Phillip Stromps
- Department of Plastic Surgery, Hand Surgery-Burn Center-University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Germany
| | - Erhan Demir
- Department of Plastic Surgery, Hand Surgery-Burn Center-University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Germany
| | - Paul C Fuchs
- Department of Plastic Surgery, Hand Surgery-Burn Center-University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Germany
| | - Jürgen Kopp
- Department of Plastic Surgery, Hand Surgery and Microsurgery, Friederikenstift, Hanover, Germany
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Banks JS, Wolfson AH, Subhawong TK. T2 signal intensity as an imaging biomarker for patients with superficial Fibromatoses of the hands (Dupuytren's disease) and feet (Ledderhose disease) undergoing definitive electron beam irradiation. Skeletal Radiol 2018; 47:243-251. [PMID: 29085992 DOI: 10.1007/s00256-017-2792-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/28/2017] [Accepted: 10/05/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Electron beam therapy is a definitive radiation treatment option for superficial fibromatoses of the hands and feet. Because objective criteria for treatment response remain poorly defined, we sought to describe changes in electron beam treated lesions on MRI. MATERIALS AND METHODS The study included 1 male and 9 female patients with a total of 37 superficial fibromatoses; average age was 60.7 years. Standard 6 MeV electron beam treatment included 3 Gy per fraction for 10 or 12 treatments using split-course with 3-month halfway break. Pre- and post-treatment MRIs were evaluated to determine lesion size (cm3), T2 signal intensity and contrast enhancement (5-point ordinal scales) by a fellowship trained musculoskeletal radiologist. MRI findings were correlated with clinical response using a composite 1-5 ordinal scale, Karnofsky Performance Scale and patient-reported 10-point visual analog scale for pain. RESULTS Mean volume decreased from 1.5 to 1.2 cm3 (p = 0.01, paired t-test). Mean T2 hyperintensity score decreased from 3.0 to 2.1 (p < 0.0001, Wilcoxon signed-rank). Mean enhancement score available for 22 lesions decreased from 3.8 to 3.0 (p < 0.0001, Wilcoxon signed-rank). Performance scores improved from 78.9 ± 13.7 to 84.6 ± 6.9 (p = 0.007, paired t-test). Pain scores decreased from 3.0 ± 3.3 to 1.1 ± 2.0 (p = 0.0001, paired t-test). Post-treatment T2 signal correlated weakly with performance and pain (Spearman's ρ = -0.37 and 0.16, respectively). CONCLUSIONS MRI is valuable for evaluating patients undergoing electron beam therapy for superficial fibromatoses: higher pretreatment T2 intensity may predict benefit from radiotherapy. T2 hypointensity may be a better marker than size for therapeutic effect.
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Affiliation(s)
- James S Banks
- Department of Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Ave. JMH WW 279, Miami, FL, 33136, USA.
| | - Aaron H Wolfson
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, 1400 NW 12th Ave, Miami, FL, 33136, USA
| | - Ty K Subhawong
- Department of Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Ave. JMH WW 279, Miami, FL, 33136, USA
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Zhou C, Liu F, Gallo PH, Baratz ME, Kathju S, Satish L. Anti-fibrotic action of pirfenidone in Dupuytren's disease-derived fibroblasts. BMC Musculoskelet Disord 2016; 17:469. [PMID: 27835939 PMCID: PMC5106805 DOI: 10.1186/s12891-016-1326-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/03/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dupuytren's disease (DD) is a complex fibro-proliferative disorder of the hand that is often progressive and eventually can cause contractures of the affected fingers. Transforming growth factor beta (TGF-β1) has been implicated as a key stimulator of myofibroblast activity and fascial contraction in DD. Pirfenidone (PFD) is an active small molecule shown to inhibit TGF-β1-mediated action in other fibrotic disorders. This study investigates the efficacy of PFD in vitro in inhibiting TGF-β1-mediated cellular functions leading to Dupuytren's fibrosis. METHODS Fibroblasts harvested from (DD) and carpal tunnel (CT)- tissues were treated with or without TGF-β1 and/or PFD and were subjected to cell migration, cell proliferation and cell contraction assays. ELISA; western blots and real time RT-PCR assays were performed to determine the levels of fibronectin; p-Smad2/Smad3; alpha-smooth muscle actin (α-SMA), α2 chain of type I collagen and α1 chain of type III collagen respectively. RESULTS Our results show that PFD effectively inhibits TGF-β1-induced cell migration, proliferation and cell contractile properties of both CT- and DD-derived fibroblasts. TGF-β1-induced α-SMA mRNA and protein levels were inhibited at the higher concentration of PFD (800 μg/ml). Interestingly, TGF-β1 induction of type I and type III collagens and fibronectin was inhibited by PFD in both CT- and DD- derived fibroblasts, but the effect was more prominent in DD cells. PFD down-regulated TGF-β1-induced phosphorylation of Smad2/Smad3, a key factor in the TGF-β1 signaling pathway. CONCLUSION Taken together these results suggest the PFD can potentially prevent TGF-β1-induced fibroblast to myofibroblast transformation and inhibit ECM production mainly Type I- and Type III- collagen and fibronectin in DD-derived fibroblasts. Further in-vivo studies with PFD may lead to a novel therapeutic application in preventing the progression or recurrence of Dupuytren's disease.
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Affiliation(s)
- Chaoming Zhou
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA 15261 USA
| | - Fang Liu
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA 15261 USA
| | - Phillip H. Gallo
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA 15261 USA
| | - Mark E. Baratz
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15261 USA
| | - Sandeep Kathju
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Latha Satish
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA USA
- Department of Plastic Surgery, University of Pittsburgh, 3550 Terrace Street, Scaife Hall, S685.2, Pittsburgh, PA 15261 USA
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Mckirdy SW, Chew B, Tzaffetta K, Naylor IL, Sharpe DT. Angiotensin receptors in Dupuytren's tissue: Implications for the pharnnacological treatment of Dupuytren's disease. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/175899830100600302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The role of Angiotensin II as a pro-fibrotic mediator has been established in models of cardiac, hepatic and renal fibrosis. The administration of Angiotensin-Converting Enzyme (ACE) – inhibitors to these models results in a reduction in the myofibroblast population and collagen synthesis. In rodent excisionat wound-healing experiments, an ACE inhibitor reduced the rate of wound contraction, collagen deposition and angiogenesis. Using immunohistochemistry, the presence of Angiotensin I receptors was identified within tissue samples from patients with Dupuytren's disease. These were found to be co-localised with areas of myofibrobtast expression. This co-localisation has implications for the potential of pharmacological regulation of Dupuytren's disease. Further research is necessary to confirm whether the use of ACE-inhibitors can modulate this disease process, which until now has not been responsive to safe, effective pharmacological treatment.
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Affiliation(s)
| | - B.K. Chew
- University of Bradford, Bradford, UK
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Augoff K, Taboła R, Kula J, Gosk J, Rutowski R. Epidermal Growth Factor Receptor (EGF-R) in Dupuytren’s Disease. ACTA ACUST UNITED AC 2016; 30:570-3. [PMID: 16055243 DOI: 10.1016/j.jhsb.2005.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Accepted: 06/09/2005] [Indexed: 10/25/2022]
Abstract
The aim of this paper was to examine participation of the epidermal growth factor receptor (EGF-R) signal pathway in the pathogenesis of Dupuytren’s disease. The study showed changes in the ratio of membrane EGF-R to its intracellular level during the different clinical stages of Dupuytren’s contracture progression. Our observations of a high ratio of surface to intracellular EGF-R in the palmar aponeurosis of patients with second degree of Dupuytren’s disease (Iselin’s classification), which was significantly higher than this ratio in control palmar fascia ( P = 0.022), would suggest that EGF-R has a role in the involutional phase of the disease.
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Affiliation(s)
- K Augoff
- Department of Traumatic Surgery and Hand Surgery, Medical University, Wrocław, Poland.
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Tripoli M, Cordova A, Moschella F. Update on the role of molecular factors and fibroblasts in the pathogenesis of Dupuytren's disease. J Cell Commun Signal 2016; 10:315-330. [PMID: 27271552 DOI: 10.1007/s12079-016-0331-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/22/2016] [Indexed: 12/17/2022] Open
Abstract
The mechanism by which the fibroblast is able to trigger palmar fibromatosis is still not yet fully understood. It would appear certain that the "abnormal" fibroblasts continuously synthesise profibrotic cytokines which are able to determine the activation to myofibroblasts, to stimulate them to the further proliferation and synthesis of other cytokines, to modify the cells' differentiation and ultrastructural characteristics, as well as the production of matrix and other proteins. Several fibroblast growth factors have been suggested to be responsible of an abnormal cell activation with an aberrantly elevated collagen synthesis and extracellular deposition in Dupuytren's disease, as TGF-Beta, TNF-Alfa, PDGF, GM-CSF, free radicals, metalloproteinases, sex hormones, gene modified expression, mechanical stimulation. The Authors review the current state of knowledge in the field, by analyzing the role of these cytokines in the palmar fibromatosis.
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10
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Rubin G, Rinott M, Wolovelsky A, Rosenberg L, Shoham Y, Rozen N. A new bromelain-based enzyme for the release of Dupuytren's contracture: Dupuytren's enzymatic bromelain-based release. Bone Joint Res 2016; 5:175-7. [PMID: 27174554 PMCID: PMC4921045 DOI: 10.1302/2046-3758.55.bjr-2016-0072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 03/14/2016] [Indexed: 01/26/2023] Open
Abstract
Objectives Injectable Bromelain Solution (IBS) is a modified investigational derivate of the medical grade bromelain-debriding pharmaceutical agent (NexoBrid) studied and approved for a rapid (four-hour single application), eschar-specific, deep burn debridement. We conducted an ex vivo study to determine the ability of IBS to dissolve-disrupt (enzymatic fasciotomy) Dupuytren’s cords. Materials and Methods Specially prepared medical grade IBS was injected into fresh Dupuytren’s cords excised from patients undergoing surgical fasciectomy. These cords were tested by tension-loading them to failure with the Zwick 1445 (Zwick GmbH & Co. KG, Ulm, Germany) tension testing system. Results We completed a pilot concept-validation study that proved the efficacy of IBS to induce enzymatic fasciotomy in ten cords compared with control in ten cords. We then completed a dosing study with an additional 71 cords injected with IBS in descending doses from 150 mg/cc to 0.8 mg/cc. The dosing study demonstrated that the minimal effective dose of 0.5 cc of 6.25 mg/cc to 5 mg/cc could achieve cord rupture in more than 80% of cases. Conclusions These preliminary results indicate that IBS may be effective in enzymatic fasciotomy in Dupuytren’s contracture. Cite this article: Dr G. Rubin. A new bromelain-based enzyme for the release of Dupuytren’s contracture: Dupuytren’s enzymatic bromelain-based release. Bone Joint Res 2016;5:175–177. DOI: 10.1302/2046-3758.55.BJR-2016-0072.
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Affiliation(s)
- G Rubin
- Orthopaedic Department, Central Emek Hospital, Afula, Israel
| | - M Rinott
- Orthopaedic Department, Central Emek Hospital, Afula, Israel
| | - A Wolovelsky
- Orthopaedic Department, Central Emek Hospital, Afula, Israel
| | - L Rosenberg
- Orthopaedic Department, Central Emek Hospital, Afula, Israel
| | - Y Shoham
- Plastic and Reconstructive Surgery Department and Hand Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - N Rozen
- Plastic and Reconstructive Surgery Department and Hand Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Joyce CW, Joyce KM, Rahmani G, Carroll SM, Kelly JL, Regan PJ. Dupuytren's Contracture: A Bibliometric Study of the Most Cited Papers. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2015; 20:402-9. [PMID: 26388001 DOI: 10.1142/s0218810415500318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The literature on Dupuytren's contracture is vast yet little information is known as to which papers have been the most influential. The purpose of this study was to identify the 50 most cited papers on Dupuytren's contracture and perform a citation analysis. Utilizing the Web of Science, 23 surgical, medical, plastic and hand surgery journals were searched for papers on Dupuytren's contracture. Resulting articles were ranked in order of times cited and each paper was analyzed for article-type, year of publication, country of origin, institution and level of evidence. The 50 most cited articles represent many important landmarks in Dupuytren's treatment and contain several seminal works by experts in the field. Whilst the top 50 list highlights the important papers on the condition, they certainly do not provide information about the quality of the evidence of the research, as most papers presented level 4 or 5 evidence.
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Affiliation(s)
- Cormac Weekes Joyce
- * Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Ireland
| | - Kenneth Mary Joyce
- * Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Ireland
| | - George Rahmani
- * Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Ireland
| | - Sean Michael Carroll
- † Department of Plastic, Reconstructive and Hand Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Jack Laurence Kelly
- * Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Ireland.,‡ Department of Plastic, Reconstructive and Hand Surgery, National University of Ireland, Galway, Ireland
| | - Padraic James Regan
- * Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Ireland.,‡ Department of Plastic, Reconstructive and Hand Surgery, National University of Ireland, Galway, Ireland
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Musumeci M, Vadalà G, Russo F, Pelacchi F, Lanotte A, Denaro V. Dupuytren's disease therapy: targeting the vicious cycle of myofibroblasts? Expert Opin Ther Targets 2015; 19:1677-87. [PMID: 26690790 DOI: 10.1517/14728222.2015.1068758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Dupuytren's disease (DD) is a proliferative fibromatosis of the hand, which causes permanent flexion contracture of the digits and, ultimately, loss of function. The treatment of DD is complex and involves surgical and nonsurgical approaches, with the goal of removing the affected tissue. New biological targets are under investigation in order to develop innovative therapies. AREAS COVERED The etiology of DD is still unknown. Several authors who focused their studies on the genetics of DD recognized an inherited autosomal dominant pattern. Actually, DD is a multifactorial and complex disease. Myofibroblasts are thought to play a crucial role in its pathogenesis, although their origin is not clear. EXPERT OPINION There is a general consensus that a better understanding of cellular and molecular mechanisms of DD will lead to the design of more specific and effective treatment alternatives. In this review, the authors hypothesize a new biological model for DD pathology, where myofibroblasts enhance the reservoir of the disease acting as if in a vicious cycle. This could help, ultimately, in identifying new therapeutic strategies to treat this common and disabling fibroproliferative disorder.
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Affiliation(s)
- Maria Musumeci
- a 1 Campus Bio-Medico University of Rome, Department of Orthopaedic and Trauma Surgery , Via Alvaro del Portillo 200, 00128 Rome, Italy +39 06 2254111192 ; +39 06 225411638 ;
| | - Gianluca Vadalà
- a 1 Campus Bio-Medico University of Rome, Department of Orthopaedic and Trauma Surgery , Via Alvaro del Portillo 200, 00128 Rome, Italy +39 06 2254111192 ; +39 06 225411638 ; .,b 2 Cell Factory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan, Italy
| | - Fabrizio Russo
- a 1 Campus Bio-Medico University of Rome, Department of Orthopaedic and Trauma Surgery , Via Alvaro del Portillo 200, 00128 Rome, Italy +39 06 2254111192 ; +39 06 225411638 ;
| | - Federica Pelacchi
- a 1 Campus Bio-Medico University of Rome, Department of Orthopaedic and Trauma Surgery , Via Alvaro del Portillo 200, 00128 Rome, Italy +39 06 2254111192 ; +39 06 225411638 ;
| | - Angela Lanotte
- a 1 Campus Bio-Medico University of Rome, Department of Orthopaedic and Trauma Surgery , Via Alvaro del Portillo 200, 00128 Rome, Italy +39 06 2254111192 ; +39 06 225411638 ;
| | - Vincenzo Denaro
- a 1 Campus Bio-Medico University of Rome, Department of Orthopaedic and Trauma Surgery , Via Alvaro del Portillo 200, 00128 Rome, Italy +39 06 2254111192 ; +39 06 225411638 ;
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Yeh CC, Huang KF, Ho CH, Chen KT, Liu C, Wang JJ, Chu CC. Epidemiological profile of Dupuytren's disease in Taiwan (Ethnic Chinese): a nationwide population-based study. BMC Musculoskelet Disord 2015; 16:20. [PMID: 25881036 PMCID: PMC4324654 DOI: 10.1186/s12891-015-0476-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/22/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The epidemiologic profile of ethnic Chinese patients with Dupuytren's disease is unknown. We therefore investigated the epidemiology of Dupuytren's disease using Taiwan's National Health Insurance Research Database. METHODS Patients who filed claims for treatment for Dupuytren's disease between January 2000 and December 2011 were identified in the database. Age- and gender-specific incidences were estimated by dividing the incidence number by population data. RESULTS We identified 1,078 patients with Dupuytren's disease (681 men, 397 women; male/female ratio: 1:1.72). The annual incidence rate ranged from 0.39-0.63/10(5) for men and 0.14-0.44/10(5) for women. A trend analysis revealed a rising trend in the annual incidence from 2001 to 2011 (p = 0.0199). The prevalence rate increased steadily from 0.46/10(5) in 2000 to 4.52/10(5) in 2011 (p = 0.0186). The mean age at onset was significantly higher in men than in women (60.7 ± 18.4 vs. 53.7 ± 15.5 years). Peak age at onset for men was 70-79 (28.1%) and for women was 50-59 (33.5%). Men > 60 years old had higher incidence rates than did women (incidence rate ratios: 2.0, 4.5, and 6.6 for those 60-69, 70-79, and ≥ 80, respectively). Hypertension (29.6%), diabetes mellitus (21.9%), hyperlipidemia (14.8%), ischemic heart disease (10.5%), and chronic obstructive pulmonary disease (8.0%) were the most common comorbidities. CONCLUSIONS The incidence and prevalence of Dupuytren's disease and the male/female ratio were significantly lower in ethnic Chinese than in Western ethnic groups. Moreover, the age at onset was significantly lower in ethnic Chinese women. However, the incidences of three comorbidities (hypertension, diabetes mellitus, and hyperlipidemia) were similar to those in other ethnicities.
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Affiliation(s)
- Chin-Choon Yeh
- Division of Plastic Surgery, Department of Surgery, Chi-Mei Medical Center, Yong-Kang, Tainan, Taiwan.
| | - Kuo-Feng Huang
- Division of Plastic Surgery, Department of Surgery, Chi-Mei Medical Center, Yong-Kang, Tainan, Taiwan.
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan. .,Department of Hospital and Health Care Administration, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
| | - Kuan-Ting Chen
- Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, 71004, Taiwan.
| | - Cheng Liu
- Division of Plastic Surgery, Department of Surgery, Chi-Mei Medical Center, Yong-Kang, Tainan, Taiwan.
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan. .,Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, 71004, Taiwan.
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, 71004, Taiwan. .,Department of Recreation and Health-Care Management, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
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Ketchum LD. The Rationale for Treating the Nodule in Dupuytren's Disease. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e278. [PMID: 25587512 PMCID: PMC4292260 DOI: 10.1097/gox.0000000000000249] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/06/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dupuytren's disease encompasses a spectrum of fibroblastic disorders from the presence of 1-2 nodules in the palm of a hand with no joint contracture to grotesque, crippling and disabling deformities of hands. Over the last 50 years, many enlightening studies have been forthcoming, which, through techniques of histopathology, biochemistry, tissue culture, and electron microscopy, have shed pearls of light on various aspects of the disease process. METHODS A comprehensive review of the literature on Dupuytren's disease was undertaken, stringing together results from numerous studies to establish a table of events and their location in the development of the disease. RESULTS What will be seen is a credible scenario of events which will enable the clinician to be more proactive in the earlier treatment of the disease and more aware of factors that increase or decrease recurrence rates postoperatively. CONCLUSIONS The most effective management of Dupuytren's disease is early recognition and treatment of the nodule, before the development of a joint contracture, particularly of a proximal interphalangeal joint. As there is evidence of a significant inflammatory role in the development of the nodule, the process of fibroplasia can be minimized by altering the macrophage > fibroblast > collagen cascade by the intralesional injection of a potent anti-inflammatory agent such as triamcinolone, which also blocks tissue inhibitors of collagenase, thus enhancing the action of native collagenase, and reduces the size and firmness of nodules and, at least temporarily, arrests their progression.
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Affiliation(s)
- Lynn D Ketchum
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kans
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Grenfell S, Borg M. Radiotherapy in fascial fibromatosis: a case series, literature review and considerations for treatment of early-stage disease. J Med Imaging Radiat Oncol 2014; 58:641-7. [PMID: 24730457 DOI: 10.1111/1754-9485.12178] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/04/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Palmar and plantar fascial fibromatoses are benign hyperproliferative disorders of the deep fascia of the palm and sole. This study seeks to examine the role of radiotherapy in the management of fascial fibromatosis. METHOD Six consecutive cases of early-stage fascial fibromatosis treated with radiotherapy at the Adelaide Radiotherapy Centre between July 2008 and May 2011 were analysed. The results of the case series were compared with a systematic review of the literature. RESULTS All six cases regressed or showed a reduction of symptoms following radiotherapy. Treatment was well tolerated with minor toxicities. Median follow-up for the case series was 38.5 months. The systematic review identified seven studies describing the use of radiotherapy as primary treatment for fascial fibromatosis between 1946 and 2013. The literature indicates that radiotherapy can prevent disease progression and improve symptoms for early-stage disease, with low likelihood of significant toxicities. CONCLUSION Early results from our case series are consistent with the literature, showing that radiotherapy can provide an effective management option for patients with early-stage fascial fibromatosis, and justify consideration of radiotherapy as a primary treatment for early-stage disease.
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Affiliation(s)
- Solveig Grenfell
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Radiotherapy Centre, Adelaide, South Australia, Australia
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16
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Abstract
Morbus Ledderhose is a rare hyperproliferative disease of the plantar fascia, leading to the formation of nodules. Its origin is unknown. No causal therapy is available, and treatment remains symptomatic. Various therapeutic strategies to alleviate symptoms are available and are adapted to the severity of the disease. In early stages, conservative therapy including nonpharmacological, physical, and pharmacological treatments is applied. If the disease progresses, irradiation of the plantar surface, injections of steroids, shock wave therapy, and partial or complete fasciectomy as an ultimate therapy may be indicated. Novel experimental treatment options including application of fibrinolytic agents are currently being tested, but no controlled, randomized long-term studies are available. This review aims to provide a systematic overview of current established procedures and outlines novel experimental strategies for the treatment of morbus Ledderhose, including future avenues to treat this rare disease.
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Affiliation(s)
- Nils T Veith
- Institute of Anatomy, Saarland University, Homburg, Germany
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Dinis-Oliveira RJ, Magalhães T, Moreira R, Proença JB, Pontes H, Santos A, Duarte JA, Carvalho F. Clinical and forensic signs related to ethanol abuse: a mechanistic approach. Toxicol Mech Methods 2013; 24:81-110. [PMID: 24274640 DOI: 10.3109/15376516.2013.869782] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Through gap junction communications, co-cultured mast cells and fibroblasts generate fibroblast activities allied with hypertrophic scarring. Plast Reconstr Surg 2013; 131:1036-1044. [PMID: 23629085 DOI: 10.1097/prs.0b013e3182865c3f] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The prominent inflammatory cell identified in excessive scarring is the mast cell. Hypertrophic scar exhibits myofibroblasts derived from the transformation of fibroblasts, increased collagen synthesis, and stationary nonmigratory resident cells. The co-culture of fibroblasts with an established rat mast cell line (RMC-1) was used to explore the hypothesis of whether mast cells through gap junctional intercellular communications guide fibroblasts in promoting excessive scarring. METHODS Human dermal fibroblasts were cultured alone or co-cultured with RMC-1 cells as is or with either blocked gap junctional intercellular communications or devoid of cytoplasmic granules. Collagen synthesis was analyzed by dot blot analysis; immunohistology identified myofibroblasts, and a cell migration assay measured fibroblast locomotion. RESULTS Fibroblasts co-cultured with RMC-1 cells transformed into myofibroblasts, had increased collagen synthesis, and showed retarded cell migration. In contrast, RMC-1 cells unable to form gap junctional intercellular communications were similar to fibroblasts alone, failing to promote these activities. Degranulated RMC-1 cells were as effective as intact RMC-1 cells. CONCLUSIONS Mast cells induce fibroblast activities associated with hypertrophic scarring through gap junctional intercellular communications. Eliminating the mast cell or its gap junctional intercellular communications with fibroblasts may be a possible approach in preventing hypertrophic scarring or reducing fibrotic conditions.
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Cross-frictional therapy and stretching for the treatment of palmar adhesions due to Dupuytren’s contracture: A prospective case study. ACTA ACUST UNITED AC 2012; 17:479-82. [DOI: 10.1016/j.math.2011.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 11/02/2011] [Accepted: 11/05/2011] [Indexed: 11/20/2022]
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20
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Ratajczak-Wielgomas K, Gosk J, Rabczyński J, Augoff K, Podhorska-Okołów M, Gamian A, Rutowski R. Expression of MMP-2, TIMP-2, TGF-β1, and decorin in Dupuytren's contracture. Connect Tissue Res 2012; 53:469-77. [PMID: 22512703 DOI: 10.3109/03008207.2012.686542] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To investigate the mechanisms underlying matrix deposition in Dupuytren's disease, the expression of gelatinase A (MMP-2), the tissue inhibitor of metalloproteinase-2 (TIMP-2), transforming growth factor beta 1 (TGF-β1), decorin (DCN), and periostin was studied. The level of relative MMP-2 activation was investigated using zymography. The mRNA expression of MMP-2, TIMP-2, TGF-β1, and DCN was detected using reverse transcription polymerase chain reaction (RT-PCR), while the presence of protein was detected using immunohistochemical (IHC) and Western blot techniques. The level of MMP-2 activation was significantly elevated in tissues with Dupuytren's contracture. RT-PCR demonstrated significantly higher expression of MMP-2, TIMP-2, TGF-β1, and DCN mRNA in the pathological tissues; and the IHC and immunoblotting studies revealed elevated expression of TGF-β1, DCN, and periostin. The balance between MMP-2 and TIMP-2 was disrupted in patients with Dupuytren's disease. TGF-β1, DCN, and periostin are involved in extracellular matrix (ECM) homeostasis in Dupuytren's contracture.
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The Surgical Release of Dupuytren's Contracture Using Multiple Transverse Incisions. Arch Plast Surg 2012; 39:426-30. [PMID: 22872850 PMCID: PMC3408292 DOI: 10.5999/aps.2012.39.4.426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 06/08/2012] [Accepted: 06/19/2012] [Indexed: 11/08/2022] Open
Abstract
Dupuytren's contracture is a condition commonly encountered by hand surgeons, although it is rare in the Asian population. Various surgical procedures for Dupuytren's contracture have been reported, and the outcomes vary according to the treatment modalities. We report the treatment results of segmental fasciectomies with multiple transverse incisions for patients with Dupuytren's contracture. The cases of seven patients who underwent multiple segmental fasciectomies with multiple transverse incisions for Dupuytren's contracture from 2006 to 2011 were reviewed retrospectively. Multiple transverse incisions to the severe contracture sites were performed initially, and additional incisions to the metacarpophalangeal (MCP) joints, and the proximal interphalangeal (PIP) joints were performed if necessary. Segmental fasciectomies by removing the fibromatous nodules or cords between the incision lines were performed and the wound margins were approximated. The mean range of motion of the involved MCP joints and PIP joints was fully recovered. During the follow-up periods, there was no evidence of recurrence or progression of disease. Multiple transverse incisions for Dupuytren's contracture are technically challenging, and require a high skill level of hand surgeons. However, we achieved excellent correction of contractures with no associated complications. Therefore, segmental fasciectomies with multiple transverse incisions can be a good treatment option for Dupuytren's contracture.
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Rehman S, Xu Y, Dunn WB, Day PJR, Westerhoff HV, Goodacre R, Bayat A. Dupuytren's disease metabolite analyses reveals alterations following initial short-term fibroblast culturing. MOLECULAR BIOSYSTEMS 2012; 8:2274-88. [PMID: 22772395 DOI: 10.1039/c2mb25173f] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Dupuytren's disease (DD) is an ill-defined fibroproliferative disorder affecting the palm of the hand, resulting in progressive and irreversible digital contracture. In view of the abnormal gene dysregulation found in DD, and its potential effect on metabolites at a functional level, we chose to examine the metabolic profile involved in DD. Using Fourier transform infrared (FT-IR) spectroscopy to generate metabolic fingerprints of cultured cells, we compared the profiles of DD cords and nodules (1) against the unaffected transverse palmar fascia (internal control), (2) against carpal ligamentous fascia (external control), and (3) against fibroblasts from fat surrounding the nodule and skin overlying the nodule (environmental control). We also determined the effects of serial passaging of the cells on DD fingerprints. Subsequently, gas chromatography-mass spectrometry (GC-MS) was employed for metabolic profiling in order to identify metabolites characteristic of the DD tissue phenotypes. We developed a robust metabolomic analysis procedure of DD using cultured fibroblasts derived from DD tissues. Our carefully controlled culture conditions, combined with assessment of metabolic phenotypes by FT-IR and GC-MS, enabled us to demonstrate metabolic differences between DD and unaffected transverse palmar fascia and between DD and healthy control tissue. In early passage (0-3) the metabolic differences were clear, but cells from subsequent passages (4-6) started to lose this distinction between diseased and non-diseased origin. The dysregulated metabolites we identified were leucine, phenylalanine, lysine, cysteine, aspartic acid, glycerol-3-phosphate and the vitamin precursor to coenzyme A. Early passage DD cells exhibit a clear metabolic profile, in which central metabolic pathways appear to be involved. Experimental conditions have been identified in which these DD data are reproducible. The experimental reproducibility will be useful in DD diagnostics and for DD systems biology.
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Affiliation(s)
- Samrina Rehman
- Doctoral Training Centre ISBML, The Manchester Centre for Integrative Systems Biology, Manchester Institute of Biotechnology, University of Manchester, Manchester, M1 7DN, UK.
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Syed F, Thomas AN, Singh S, Kolluru V, Emeigh Hart SG, Bayat A. In vitro study of novel collagenase (XIAFLEX®) on Dupuytren's disease fibroblasts displays unique drug related properties. PLoS One 2012; 7:e31430. [PMID: 22384021 PMCID: PMC3286458 DOI: 10.1371/journal.pone.0031430] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 01/08/2012] [Indexed: 11/19/2022] Open
Abstract
Dupuytren's disease (DD) is a benign, fibroproliferative disease of the palmar fascia, with excessive extracellular matrix (ECM) deposition and over-production of cytokines and growth factors, resulting in digital fixed flexion contractures limiting hand function and patient quality of life. Surgical fasciectomy is the gold standard treatment but is invasive and has associated morbidity without limiting disease recurrence. Injectable Collagenase Clostridium histolyticum (CCH)--Xiaflex®--is a novel, nonsurgical option with clinically proven in vivo reduction of DD contractures but with limited in vitro data demonstrating its cellular and molecular effects. The aim of this study was to delineate the effects of CCH on primary fibroblasts isolated from DD and non-DD anatomical sites (using RTCA, LDH, WST-1, FACS, qRT-PCR, ELISA and In-Cell Quantitative Western Blotting) to compare the efficacy of varying concentrations of Xiaflex® against a reagent grade Collagenase, Collagenase A. Results demonstrated that DD nodule and cord fibroblasts had greater proliferation than those from fat and skin. Xiaflex® exposure resulted in dose- and time-dependent inhibition of cellular spreading, attachment and proliferation, with cellular recovery after enzyme removal. Unlike Collagenase A, Xiaflex® did not cause apoptosis. Collagen expression patterns were significantly (p<0.05) different in DD fibroblasts across anatomical sites - the highest levels of collagen I and III were detected in DD nodule, with DD cord and fat fibroblasts demonstrating a smaller increase in both collagen expression relative to DD skin. Xiaflex® significantly (p<0.05) down-regulated ECM components, cytokines and growth factors in a dose-dependent manner. An in vitro scratch wound assay model demonstrated that, at low concentrations, Xiaflex® enabled a faster fibroblast reparatory migration into the wound, whereas, at high concentrations, this process was significantly (p<0.05) inhibited. This is the first report elucidating potential mechanisms of action of Xiaflex® on Dupuytren fibroblasts, offering a greater insight and a better understanding of its effect in DD.
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Affiliation(s)
- Farhatullah Syed
- Plastic and Reconstructive Surgery Research, School of Translational Medicine, Manchester Interdisciplinary Biocentre, University of Manchester, Manchester, United Kingdom
- Inflammation Sciences Group, School of Translational Medicine, University of Manchester, Manchester, United Kingdom
| | - Alexis N. Thomas
- Plastic and Reconstructive Surgery Research, School of Translational Medicine, Manchester Interdisciplinary Biocentre, University of Manchester, Manchester, United Kingdom
| | - Subir Singh
- Plastic and Reconstructive Surgery Research, School of Translational Medicine, Manchester Interdisciplinary Biocentre, University of Manchester, Manchester, United Kingdom
| | - Venkatesh Kolluru
- Plastic and Reconstructive Surgery Research, School of Translational Medicine, Manchester Interdisciplinary Biocentre, University of Manchester, Manchester, United Kingdom
| | | | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research, School of Translational Medicine, Manchester Interdisciplinary Biocentre, University of Manchester, Manchester, United Kingdom
- Inflammation Sciences Group, School of Translational Medicine, University of Manchester, Manchester, United Kingdom
- Department of Plastic and Reconstructive Surgery, University Hospital South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
- Manchester Academic Health Science Centre, University Hospital South Manchester NHS Foundation Trust, Wythenshawe Hospital, University of Manchester, Manchester, United Kingdom
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R M, S H, W K. Recent Surgical and Medical Advances in the Treatment of Dupuytren's Disease - A Systematic Review of the Literature. Open Orthop J 2012; 6:77-82. [PMID: 22431952 PMCID: PMC3293169 DOI: 10.2174/1874325001206010077] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 10/28/2011] [Accepted: 10/30/2011] [Indexed: 12/13/2022] Open
Abstract
Dupuytren’s disease (DD) is a type of fibromatosis which progressively results in the shortening and thickening of the fibrous tissue of the palmar fascia. This condition which predominantly affects white-northern Europeans has been identified since 1614. DD can affect certain activities of daily living such as face washing, combing hair and putting hand in a glove. The origin of Dupuytren’s contracture is still unknown, but there are a number of treatments that doctors have come across throughout the years. Historically surgery has been the mainstay treatment for DD but not the only one. The objective is to make a structured review of the most recent advances in treatment of DD including the surgical and medical interventions. We have looked at the most relevant published articles regarding the various treatment options for DD. This review has taken 55 articles into consideration which have met the inclusion criteria. The most recent treatments used are multi-needle aponeurotomy, extensive percutaneous aponeurotomy and lipografting, injecting collagenase Clostridium histolyticum, INF-gamma and shockwave therapy as well as radiotherapy. Each of these treatments has certain advantages and drawbacks and cannot be used for every patient. In order to prevent this condition, spending more time and money in the topic is required to reach better and more consistent treatments and ultimately to eradicate this disease.
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Affiliation(s)
- Mafi R
- The Hull York Medical School, Hertford Building, Hull, HU6 7RX, UK
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25
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Krause C, Kloen P, Ten Dijke P. Elevated transforming growth factor β and mitogen-activated protein kinase pathways mediate fibrotic traits of Dupuytren's disease fibroblasts. FIBROGENESIS & TISSUE REPAIR 2011; 4:14. [PMID: 21711521 PMCID: PMC3148569 DOI: 10.1186/1755-1536-4-14] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 06/28/2011] [Indexed: 11/24/2022]
Abstract
Background Dupuytren's disease is a fibroproliferative disorder of the palmar fascia. The treatment used to date has mostly been surgery, but there is a high recurrence rate. Transforming growth factor β (TGF-β) has been implicated as a key stimulator of myofibroblast activity and fascial contraction in Dupuytren's disease. Results We studied Dupuytren's fibroblasts in tissues ex vivo and in cells cultured in vitro and found increased TGF-β expression compared to control fibroblasts. This correlated not only with elevated expression and activation of downstream Smad effectors but also with overactive extracellular signal-regulated kinase 1/2 (ERK1/2)/mitogen-activated protein (MAP) kinase signalling. Treatment with the TGF-β type I receptor kinase inhibitor SB-431542 and bone morphogenetic protein 6 (BMP6) led to inhibition of elevated Smad and ERK1/2/MAP kinase signalling as well as to inhibition of the increased contractility of Dupuytren's fibroblasts. BMP6 attenuated TGF-β expression in Dupuytren's fibroblasts, but not in control fibroblasts. Platelet-derived growth factor (PDGF) expression was strongly promoted by TGF-β in Dupuytren's fibroblasts and was curbed by SB-431542 or BMP6 treatment. High basal expression of phosphorylated ERK1/2 MAP kinase and fibroproliferative markers was attenuated in Dupuytren's fibroblasts by a selective PDGF receptor kinase inhibitor. Cotreatment of Dupuytren's fibroblasts with SB-431542 and the mitogen-activated protein kinase kinase 1 inhibitor PD98059 was sufficient to abrogate proliferation and contraction of Dupuytren's fibroblasts. Conclusions Both TGF-β and ERK1/2 MAP kinase pathways cooperated in mediating the enhanced proliferation and high spontaneous contraction of Dupuytren's fibroblasts. Our data indicate that both signalling pathways are prime targets for the development of nonsurgical intervention strategies to treat Dupuytren's disease.
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Affiliation(s)
- Carola Krause
- Department of Molecular Cell Biology and Centre for Biomedical Genetics, Leiden University Medical Center, Einthovenweg 20, 2333 ZC Leiden, The Netherlands.
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Abstract
BACKGROUND Previous studies suggest that Dupuytren's disease is caused by fibroblast and myofibroblast contractility. Cell contractility in smooth muscle cells is caused by calcium-dependent and calcium-independent signaling mechanisms. In the calcium-dependent pathway, calcium/calmodulin activates myosin light chain kinase (MLCK). In this study, the effects of calcium/calmodulin inhibition with the FDA-approved drug fluphenazine on Dupuytren's fibroblast contractility and MLCK expression were tested. METHODS Fibroblast lines from the palmar fascia of patients with Dupuytren's disease were explanted and used for in vitro study. The effect of fluphenazine on Dupuytren's fibroblast migration was determined using a scratch migration assay, and contractility was determined using fibroblast-populated collagen lattice (FPCL) assays. Immunohistochemical staining of MLCK in different samples of Dupuytren's tissue and normal fascia were compared. RESULTS Fluphenazine demonstrated a dose-dependent inhibition of Dupuytren's fibroblast migration, with the maximum inhibition of migration observed at 20 μM (69.8 ± 1.9%). Fluphenazine also inhibited FPCL contraction in a dose-dependent manner. Maximal inhibition was observed at a fluphenazine concentration of 20 μM (52.5 ± 6.1%). Immunohistological staining illustrated that MLCK was predominantly expressed throughout the cytoplasm of select fibroblasts within Dupuytren's nodules, yet was absent in the fibroblasts of Dupuytren's cords and normal palmar fascia. CONCLUSIONS Fluphenazine inhibits Dupuytren's fibroblast contractility and migration through inhibition of MLCK in vitro. However, the inconsistent expression of MLCK throughout Dupuytren's tissue suggests that calcium-dependent signaling may not be a primary mode of contracture formation. Fluphenazine inhibition of MLCK is not likely to be a target for the treatment of Dupuytren's disease.
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Satish L, Gallo PH, Baratz ME, Johnson S, Kathju S. Reversal of TGF-β1 stimulation of α-smooth muscle actin and extracellular matrix components by cyclic AMP in Dupuytren's-derived fibroblasts. BMC Musculoskelet Disord 2011; 12:113. [PMID: 21612641 PMCID: PMC3125251 DOI: 10.1186/1471-2474-12-113] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 05/25/2011] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Myofibroblasts, a derived subset of fibroblasts especially important in scar formation and wound contraction, have been found at elevated levels in affected Dupuytren's tissues. Transformation of fibroblasts to myofibroblasts is characterized by expression of alpha- smooth muscle actin (α-SMA) and increased production of extracellular matrix (ECM) components, both events of relevance to connective tissue remodeling. We propose that increasing the activation of the cyclic AMP (cAMP)/protein kinase A signaling pathway will inhibit transforming growth factor-beta1 (TGF-β1)-induced ECM synthesis and myofibroblast formation and may provide a means to blunt fibrosis. METHODS Fibroblasts derived from areas of Dupuytren's contracture cord (DC), from adjacent and phenotypically normal palmar fascia (PF), and from palmar fascia from patients undergoing carpal tunnel release (CTR; CT) were treated with TGF-β1 (2 ng/ml) and/or forskolin (10 μM) (a known stimulator of cAMP). Total RNA and protein extracted was subjected to real time RT-PCR and Western blot analysis. RESULTS The basal mRNA expression levels of fibronectin- extra domain A (FN1-EDA), type I (COL1A2) and type III collagen (COL3A1), and connective tissue growth factor (CTGF) were all significantly increased in DC- and in PF-derived cells compared to CT-derived fibroblasts. The TGF-β1 stimulation of α-SMA, CTGF, COL1A2 and COL3A1 was greatly inhibited by concomitant treatment with forskolin, especially in DC-derived cells. In contrast, TGF-β1 stimulation of FN1-EDA showed similar levels of reduction with the addition of forskolin in all three cell types. CONCLUSION In sum, increasing cAMP levels show potential to inhibit the formation of myofibroblasts and accumulation of ECM components. Molecular agents that increase cAMP may therefore prove useful in mitigating DC progression or recurrence.
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Affiliation(s)
- Latha Satish
- Center for Genomic Sciences, Allegheny-Singer Research Institute, Pittsburgh, PA-15212, USA
| | - Phillip H Gallo
- Center for Genomic Sciences, Allegheny-Singer Research Institute, Pittsburgh, PA-15212, USA
| | - Mark E Baratz
- Division of Upper Extremity Surgery, Department of Orthopaedics, Allegheny General Hospital, Pittsburgh, PA-15212, USA
| | - Sandra Johnson
- Center for Genomic Sciences, Allegheny-Singer Research Institute, Pittsburgh, PA-15212, USA
| | - Sandeep Kathju
- Center for Genomic Sciences, Allegheny-Singer Research Institute, Pittsburgh, PA-15212, USA
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28
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Kozma EM, Wisowski G, Kusz D, Olczyk K. The role of decorin and biglycan dermatan sulfate chain(s) in fibrosis-affected fascia. Glycobiology 2011; 21:1301-16. [DOI: 10.1093/glycob/cwr065] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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[Dupuytren's disease: state of knowledge and research in physiopathology]. ACTA ACUST UNITED AC 2011; 30:239-45. [PMID: 21592840 DOI: 10.1016/j.main.2011.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Revised: 01/23/2011] [Accepted: 03/23/2011] [Indexed: 11/22/2022]
Abstract
From Baron Dupuytren's historical description up to the advent of molecular biology, many hypotheses about the etiology of Dupuytren's disease have been proposed. This bibliography of the last ten years' publications describes tissue anomalies from the macroscopic down to the ultrastructural level of pathology. The myofibroblast, which is the principal cell of the disease, is the seat of genetics anomalies involving proto-oncogenes (c-myc and MafB). Similarly, glycoproteins implicated in cellular adhesion like fibronectins and catenins are modified and overexpressed in the disease. Extracellular proteins of the metalloproteinase family exhibit many dysfunctions responsible for collagenic proliferation. Finally, growth factors like Transforming Growth Factor (TGF) and Epidermal Growth Factor (EGF) receptor maintain and worsen the disease and could be therapeutic targets in the future.
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Hindocha S, Iqbal SA, Farhatullah S, Paus R, Bayat A. Characterization of stem cells in Dupuytren's disease. Br J Surg 2011; 98:308-15. [PMID: 21104823 DOI: 10.1002/bjs.7307] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Dupuytren's disease (DD) is a common fibroproliferative disease of unknown origin. The source of abnormal cells leading to DD formation remains underexplored. In addition to fascia, palmar skin and fat-derived cells may be a potential source of cells causing DD. This study aimed to profile haematopoietic and mesenchymal stem cells in different DD tissue components compared with tissue removed at carpal tunnel surgery (control). METHODS Biopsies were taken from the diseased cord, nodule, perinodular fat and skin overlying the nodule of ten patients with DD and compared with control tissue from seven patients having surgery for carpal tunnel syndrome. Fluorescence-activated cell sorting (FACS), immunohistochemistry and quantitative real-time polymerase chain reaction (QRT-PCR) were used to identify expression of selected stem cell markers. RESULTS FACS and QRT-PCR analysis identified the highest RNA expression and number of cells positive for adipocyte stem cell markers (CD13 and CD29) in the DD nodule in comparison with carpal tunnel control tissue (P = 0·053). CD34 RNA was overexpressed, and a higher percentage of these cells was present in DD skin compared with carpal tunnel skin (P = 0·001). CONCLUSION Each structural component of DD (cord, nodule, perinodular fat and skin) had distinct stem cell populations. These findings support the hypothesis that DD may result from mesenchymal progenitor cell expansion.
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Affiliation(s)
- S Hindocha
- Plastic and Reconstructive Surgery Research, Manchester Interdisciplinary Biocentre, University of Manchester, Manchester, UK
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Komatsu I, Bond J, Selim A, Tomasek JJ, Levin LS, Levinson H. Dupuytren's fibroblast contractility by sphingosine-1-phosphate is mediated through non-muscle myosin II. J Hand Surg Am 2010; 35:1580-8. [PMID: 20888494 PMCID: PMC2953964 DOI: 10.1016/j.jhsa.2010.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 06/27/2010] [Accepted: 07/06/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE Previous studies suggest that Dupuytren's disease is caused by fibroblast and myofibroblast contractility within Dupuytren's nodules; however, the stimulus for cell contractility is unknown. Sphingosine-1-phosphate (S1P) is a serum-derived lysophospholipid mediator that enhances cell contractility by activating the S1P receptor, S1P(2). It is hypothesized that S1P stimulates Dupuytren's fibroblast contractility through S1P(2) activation of non-muscle myosin II (NMMII). This investigation examined the role of S1P and NMMII activation in Dupuytren's disease progression and suggests potential targets for treatment. METHODS We enmeshed Dupuytren's fibroblasts into fibroblast-populated collagen lattices (FPCLs) and assayed S1P-stimulated FPCL contraction in the presence of the S1P(2) receptor inhibitor JTE-013, the Rho kinase inhibitor Y-27632, the myosin light chain kinase inhibitor ML-7, and the NMMII inhibitor blebbistatin. Tissues from Dupuytren's fascia (n = 10) and normal palmar fascia (n = 10) were immunostained for NMMIIA and NMMIIB. RESULTS Sphingosine-1-phosphate stimulated FPCL contraction in a dose-dependent manner. Inhibition of S1P(2) and NMMII prevented S1P-stimulated FPCL contraction. Rho kinase and myosin light chain kinase inhibited both S1P and control FPCL contraction. Dupuytren's nodule fibroblasts robustly expressed NMMIIA and NMMIIB, compared with quiescent-appearing cords and normal palmar fascia. CONCLUSIONS Sphingosine-1-phosphate promotes Dupuytren's fibroblast contractility through S1P(2), which stimulates activation of NMMII. NMMII isoforms are ubiquitously expressed throughout Dupuytren's nodules, which suggests that nodule fibroblasts are primed to respond to S1P stimulation to cause contracture formation. S1P-promoted activation of NMMII may be a target for disease treatment.
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Affiliation(s)
- Issei Komatsu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jennifer Bond
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Angelica Selim
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - James J Tomasek
- Department of Cell Biology, University of Oklahoma-Health Sciences Center, Oklahoma City, Oklahoma
| | - L Scott Levin
- Department of Orthopeadics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Howard Levinson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina,Department of Pathology, Duke University Medical Center, Durham, North Carolina
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McCarty S, Syed F, Bayat A. Role of the HLA System in the Pathogenesis of Dupuytren's Disease. Hand (N Y) 2010; 5:241-50. [PMID: 21886544 PMCID: PMC2920393 DOI: 10.1007/s11552-009-9255-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 12/28/2009] [Indexed: 10/19/2022]
Abstract
Dupuytren's disease (DD) is a familial, fibroproliferative, irreversible, and progressive disease of the palmar fascia, yet with unknown etiology. However, there is compelling evidence which has consistently suggested a genetic ethiopathogenesis given the high occurrence among the Northern European extraction, familial nature, and demonstration of concordance in twins. DD is an incurable, recurrent, and potentially debilitating disease with limited and ineffective treatments. Although a number of possible candidate genes have been investigated including matrix metalloproteinases (MMPs) and transforming growth factor-beta (TGF-β) genes, as yet, no consistent genetic biomarker has been identified for DD. The highly polymorphic human leukocyte antigen (HLA) region is an ideal biomarker target. There have been some coherent data within the literature to suggest a genotype to phenotype association between certain HLA loci and a number of fibrotic disorders such as keloid and scleroderma, markedly with class II molecules and disease pervasiveness and clinical progression. The aim of this review, therefore, was to investigate the evidence indicative of both positive and negative associations between particular HLA alleles and DD. There is a clear association with specific HLA alleles and predilection or protection to DD, though there is a pressing need for further supportive data. The most promising of links to the HLA region in terms of a definitive genetic biomarker is with the class II HLA-DR loci. This paper presents a detailed account of the immunogenetic component of DD and explores the possible mechanisms of association between specific HLA molecules and susceptibility to DD.
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Myofibroblast distribution in Dupuytren's cords: correlation with digital contracture. J Hand Surg Am 2009; 34:1785-94. [PMID: 19910144 DOI: 10.1016/j.jhsa.2009.08.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 08/11/2009] [Accepted: 08/13/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE Dupuytren's tissue has typically been described as being composed of myofibroblast-rich palmar nodules and relatively acellular tendon-like cords. We aimed to determine myofibroblast distribution (alpha-smooth muscle actin [alpha-SMA] positive cells) within Dupuytren's tissue and to correlate histologically defined alpha-SMA-positive nodules with digital contracture and recurrent disease. METHODS One hundred and three digital Dupuytren's cords (72 fasciectomy, 31 dermofasciectomy) were stained with anti-alpha-SMA antibody. The presence of alpha-SMA-positive nodules, their surface area, and alpha-SMA-positive cells were quantified throughout excised Dupuytren's tissue. Clinical data on diathesis, flexion deformity, and previous surgeries were collected. RESULTS Cords were nodular (66%) or non-nodular (34%). Nodular cords contained 1 (55%), 2 (33%), or 3 or more nodules (12%) composed of localized collections of cells. The mean total nodule surface area was 23 mm(2) (range, 1.3-105 mm(2)). Nodules contained the highest number of alpha-SMA-positive cells (mean 97%, 2374 cells/mm(2)) compared to peri-nodular areas (mean 32%, 763 cells/mm(2)), and more distant cord (mean 8%, 495 cells/mm(2)). Non-nodular cords contained 9% to 17% alpha-SMA-positive cells (mean 475-663 cells/mm(2)), with higher numbers distally. There was greater digital contracture in patients with non-nodular cords. Thirty-six of 38 proximal interphalangeal (PIP) joint-marked samples had a nodule that co-localized with the PIP joint. Nodule size did not correlate with flexion deformity or with primary or recurrent disease. CONCLUSIONS We found that two thirds of digital cords were nodular. Nodules were hypercellular, the majority being alpha-SMA-positive cells. Nodules varied in size and co-localized with the PIP joint. Cord was relatively cellular throughout; a proportion of these cells were alpha-SMA-positive and cells aligned with collagen fibers. Non-nodular cords correlated with significantly greater digital flexion contracture. We propose that cells in nodular cords contract and deposit extracellular matrix components. The matrix is then remodeled in shortened configuration, and as fixed flexion deformity develops, stress shielding eventually leads to myofibroblast apoptosis, and cord becomes less cellular.
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Abstract
Tissues lose mechanical integrity when our body is injured. To rapidly restore mechanical stability a multitude of cell types can jump into action by acquiring a reparative phenotype-the myofibroblast. Here, I review the known biomechanics of myofibroblast differentiation and action and speculate on underlying mechanisms. Hallmarks of the myofibroblast are secretion of extracellular matrix, development of adhesion structures with the substrate, and formation of contractile bundles composed of actin and myosin. These cytoskeletal features not only enable the myofibroblast to remodel and contract the extracellular matrix but to adapt its activity to changes in the mechanical microenvironment. Rapid repair comes at the cost of tissue contracture due to the inability of the myofibroblast to regenerate tissue. If contracture and ECM remodeling become progressive and manifests as organ fibrosis, the outcome of myofibroblast activity will have more severe consequences than the initial damage. Whereas the pathological consequences of myofibroblast occurrence are of great interest for physicians, their mechano-responsive features render them attractive for physicists and bioengineers. Their well developed cytoskeleton and responsiveness to a plethora of cytokines fascinate cell biologists and biochemists. Finally, the question of the myofibroblast origin intrigues stem cell biologists and developmental biologists-what else can you ask from a truly interdisciplinary cell?
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Affiliation(s)
- Boris Hinz
- Laboratory of Tissue Repair and Regeneration, CIHR Group in Matrix Dynamics, Faculty of Dentistry, University of Toronto, Fitzgerald Building, Room 241, 150 College Street, Toronto, Canada ON M5S 3E2.
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Hindocha S, McGrouther DA, Bayat A. Epidemiological evaluation of Dupuytren's disease incidence and prevalence rates in relation to etiology. Hand (N Y) 2009; 4:256-69. [PMID: 19145463 PMCID: PMC2724613 DOI: 10.1007/s11552-008-9160-9] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 12/15/2008] [Indexed: 11/29/2022]
Abstract
Dupuytren's Disease (DD) is a common, fibroproliferative disorder affecting the palmar surface of the hands which is often irreversible and progressive. Understanding the epidemiology of DD is important in order to provide clues to its etiopathogenesis. This review aims to evaluate the epidemiological studies carried out in DD since 1951. Studies evaluating the epidemiology of DD were searched using Medline, Pubmed, and Scopus which dated back from 1951 to current date. Inclusion criteria were any studies investigating the prevalence or incidence of DD in any population group. A total of 620 articles were cited. Forty-nine studies were subsequently identified as relevant to evaluating the epidemiology of DD. The prevalence of DD in all studies increased with age with a male to female ratio of approximately 5.9:1. Prevalence rates ranged from 0.2% to 56% in varying age, population groups, and methods of data collection. The highest prevalence rate was reported in a study group of epileptic patients. Although, only one study calculated the incidence (as opposed to prevalence) of DD to be equal to 34.3 per 100,000 men (0.03%). In conclusion, the prevalence of DD in different geographical locations is extremely variable, and it is not clear whether this is genetic, environmental, or a combination of both. The majority of the prevalence studies have been conducted in Scandinavia or the UK, and the vast changes in population structure, the changes in prevalence of associated diseases, and the change in diagnostic criteria of DD makes understanding the epidemiology of this condition difficult.
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Affiliation(s)
- Sandip Hindocha
- Plastic and Reconstructive Surgery Research, Manchester Interdisciplinary Biocenter, University of Manchester, 131 Princess St, Manchester, M1 7DN. England UK
| | - Duncan Angus McGrouther
- Plastic and Reconstructive and Hand Surgery, South Manchester University Hospital Foundation Trust, Wythenshawe Hospital. Southmoor Road, Wythenshawe, Manchester, M23 9LT England UK
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research, Manchester Interdisciplinary Biocenter, University of Manchester, 131 Princess St, Manchester, M1 7DN. England UK
- Plastic and Reconstructive and Hand Surgery, South Manchester University Hospital Foundation Trust, Wythenshawe Hospital. Southmoor Road, Wythenshawe, Manchester, M23 9LT England UK
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Degreef I, De Smet L, Sciot R, Cassiman JJ, Tejpar S. Immunohistochemical evidence for Zic1 coexpression with β-catenin in the myofibroblast of Dupuytren disease. ACTA ACUST UNITED AC 2009; 43:36-40. [DOI: 10.1080/02844310802489806] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Vi L, Njarlangattil A, Wu Y, Gan BS, O'Gorman DB. Type-1 Collagen differentially alters beta-catenin accumulation in primary Dupuytren's Disease cord and adjacent palmar fascia cells. BMC Musculoskelet Disord 2009; 10:72. [PMID: 19545383 PMCID: PMC2716298 DOI: 10.1186/1471-2474-10-72] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 06/19/2009] [Indexed: 12/14/2022] Open
Abstract
Background Dupuytren's Disease (DD) is a debilitating contractile fibrosis of the palmar fascia characterised by excess collagen deposition, contractile myofibroblast development, increased Transforming Growth Factor-β levels and β-catenin accumulation. The aim of this study was to determine if a collagen-enriched environment, similar to in vivo conditions, altered β-catenin accumulation by primary DD cells in the presence or absence of Transforming Growth Factor-β. Methods Primary DD and patient matched, phenotypically normal palmar fascia (PF) cells were cultured in the presence or absence of type-1 collagen and Transforming Growth Factor-β1. β-catenin and α-smooth muscle actin levels were assessed by western immunoblotting and immunofluorescence microscopy. Results DD cells display a rapid depletion of cellular β-catenin not evident in patient-matched PF cells. This effect was not evident in either cell type when cultured in the absence of type-1 collagen. Exogenous addition of Transforming Growth Factor-β1 to DD cells in collagen culture negates the loss of β-catenin accumulation. Transforming Growth Factor-β1-induced α-smooth muscle actin, a marker of myofibroblast differentiation, is attenuated by the inclusion of type-1 collagen in cultures of DD and PF cells. Conclusion Our findings implicate type-1 collagen as a previously unrecognized regulator of β-catenin accumulation and a modifier of TGF-β1 signaling specifically in primary DD cells. These data have implications for current treatment modalities as well as the design of in vitro models for research into the molecular mechanisms of DD.
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Affiliation(s)
- Linda Vi
- Cell and Molecular Biology Laboratory, Hand and Upper Limb Centre, Lawson Health Research Institute, London, Canada.
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Myofibroblasts work best under stress. J Bodyw Mov Ther 2008; 13:121-7. [PMID: 19329048 DOI: 10.1016/j.jbmt.2008.04.031] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 04/04/2008] [Indexed: 01/17/2023]
Abstract
Myofibroblasts are reparative connective tissue cells that contribute to the reconstruction of injured tissue by secreting new extracellular matrix and by exerting high contractile force. Deregulation of these activities results in tissue contracture and development of fibrosis which makes the myofibroblast an important target for anti-fibrotic therapies. Two principle factors drive the development of myofibroblasts from different precursor cells and guarantee maintenance of the contractile phenotype: mechanical stress and transforming growth factor beta (TGFbeta1). In this mini-review, we recapitulate the current understanding (1) of how myofibroblasts feel stress using specialized matrix adhesions, (2) of the level of stress that is required to induce their development and (3) of how myofibroblast mechanical activity can have a direct influence on the level of TGFbeta1 activation. From these findings it emerges that the specific matrix adhesion structures of myofibroblasts are promising targets to modulate myofibroblast differentiation and activity.
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Satish L, LaFramboise WA, O'Gorman DB, Johnson S, Janto B, Gan BS, Baratz ME, Hu FZ, Post JC, Ehrlich GD, Kathju S. Identification of differentially expressed genes in fibroblasts derived from patients with Dupuytren's Contracture. BMC Med Genomics 2008; 1:10. [PMID: 18433489 PMCID: PMC2377253 DOI: 10.1186/1755-8794-1-10] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 04/23/2008] [Indexed: 11/10/2022] Open
Abstract
Dupuytren's contracture (DC) is the most common inherited connective tissue disease of humans and is hypothesized to be associated with aberrant wound healing of the palmar fascia. Fibroblasts and myofibroblasts are believed to play an important role in the genesis of DC and the fibroproliferation and contraction that are hallmarks of this disease. This study compares the gene expression profiles of fibroblasts isolated from DC patients and controls in an attempt to identify key genes whose regulation might be significantly altered in fibroblasts found within the palmar fascia of Dupuytren's patients. Total RNA isolated from diseased palmar fascia (DC) and normal palmar fascia (obtained during carpal tunnel release; 6 samples per group) was subjected to quantitative analyses using two different microarray platforms (GE Code Linktrade mark and Illuminatrade mark) to identify and validate differentially expressed genes. The data obtained was analyzed using The Significance Analysis of Microarrays (SAM) software through which we identified 69 and 40 differentially regulated gene transcripts using the CodeLinktrade mark and Illuminatrade mark platforms, respectively. The CodeLinktrade mark platform identified 18 upregulated and 51 downregulated genes. Using the Illuminatrade mark platform, 40 genes were identified as downregulated, eleven of which were identified by both platforms. Quantitative RT-PCR confirmed the downregulation of three high-interest candidate genes which are all components of the extracellular matrix: proteoglycan 4 (PRG4), fibulin-1 (FBLN-1) transcript variant D, and type XV collagen alpha 1 chain. Overall, our study has identified a variety of candidate genes that may be involved in the pathophysiology of Dupuytren's contracture and may ultimately serve as attractive molecular targets for alternative therapies.
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Affiliation(s)
- Latha Satish
- Center for Genomic Sciences, Allegheny-Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA, USA.
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Tanaka K, Sano K, Nakano T, Yuba K, Kinoshita M. Suppression ofαSmooth Muscle Actin Expression by IFN-γin Established Myofibroblast Cell Lines. J Interferon Cytokine Res 2007; 27:835-9. [DOI: 10.1089/jir.2007.0028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kazunari Tanaka
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Kouichi Sano
- Department of Microbiology, Osaka Medical College, Osaka, Japan
| | - Takashi Nakano
- Department of Microbiology, Osaka Medical College, Osaka, Japan
| | - Kazuhide Yuba
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Mitsuo Kinoshita
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
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Forsman M, Pääkkönen V, Tjäderhane L, Vuoristo J, Kallioinen L, Salo T, Kallioinen M, Ryhänen J. The expression of myoglobin and ROR2 protein in Dupuytren's disease. J Surg Res 2007; 146:271-5. [PMID: 17996904 DOI: 10.1016/j.jss.2007.06.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 05/29/2007] [Accepted: 06/21/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dupuytren's disease (DD) is a hand disease inherited as an autosomal dominant trait with variable penetrance, especially among populations of northern European ancestry. The etiology and pathophysiology of DD are not clear. The purpose of this study was to examine the gene expression profiles of palmar fascia of DD and healthy patients using microarray analysis to highlight the genes that might contribute to the pathogenesis of DD. MATERIALS AND METHODS Dupuytren contracture samples were taken from excised mature cords of DD patients during aponeurectomies. Control samples were collected from healthy hand trauma patients. Microarray analysis was performed with the Affymetrix HGU133A genome array (Affymetrix, Santa Clara, CA). Expression changes of selected proteins were confirmed at the protein level with Western and dot blotting or by immunohistochemistry. RESULTS At least an 8-fold change in gene expression was found with 127 genes, including a 90-fold down-regulation of myoglobin and a 14-fold up-regulation of tyrosine kinase-like orphan receptor 2 (= ROR2) from absent to present during the disease. The changes in myoglobin and ROR2 expression were confirmed at the protein level. CONCLUSIONS In this study, we showed for the first time the connection of ROR2 in Dupuytren's disease. ROR2 and myoglobin may play an important role in the pathophysiology of this disease.
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Affiliation(s)
- Minna Forsman
- Department of Surgery, Oulu University, Oulu, Finland.
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Augoff K, Ratajczak K, Gosk J, Tabola R, Rutowski R. Gelatinase A activity in Dupuytren's disease. J Hand Surg Am 2006; 31:1635-9. [PMID: 17145384 DOI: 10.1016/j.jhsa.2006.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 08/14/2006] [Accepted: 08/15/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE Dupuytren's contracture is a fibroproliferative disorder of the hand characterized by an abnormal myofibroblast and fibroblast proliferation and extracellular matrix deposition leading to retraction and deformation of the palm. Recent studies have shown that molecules of extracellular matrix may coordinate morphogenesis, cell differentiation, and most importantly, fibrogenesis in tissue. Gelatinase A (MMP-2) is a member of the matrix metalloproteinase family of proteolytic enzymes that contribute to remodeling the extracellular matrix by degrading its components. The aim of this study was to determine the level of MMP-2 activation in the palmar fascia of patients with Dupuytren's contracture with reference to the clinical stages of disease progression and recurrence of the contracture after surgery. METHODS The level of relative MMP-2 activation, expressed by the active to latent MMP-2 ratio, was investigated with use of zymography and computerized densitometry in 16 normal and 71 pathologic tissues characterizing different clinical stages of the disease progression. RESULTS We found that the level of MMP-2 activation was significantly elevated in the palmar fascias with Dupuytren's contracture compared with normal tissues. We did not find statistically significant differences between groups with different stages of the disease progression. We also did not find a relation between a high level of MMP-2 activation and the recurrence in the area of surgically treated Dupuytren's contracture. CONCLUSIONS The differences in MMP-2 activation between contractured and normal fascia suggest a participation of this enzyme in the promotion of Dupuytren's disease. We did not find a relationship, however, between the level of MMP-2 activation and the secondary contracture.
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Affiliation(s)
- Katarzyna Augoff
- Department of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland.
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Abstract
This article reviews the basic science elements involved in the pathogenesis of Dupuytren's disease. Dupuytren's contracture is effected by a multitude of complex processes at the cellular level and the exact relative contribution of each is unknown. Various investigators have proposed different theories and documented individual findings regarding the pathophysiology of Dupuytren's contracture. The current report attempts to summarize many of these findings together in a schema of pathogenesis.
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Gonzalez-Cadavid NF, Rajfer J. Mechanisms of Disease: new insights into the cellular and molecular pathology of Peyronie's disease. ACTA ACUST UNITED AC 2006; 2:291-7. [PMID: 16474811 DOI: 10.1038/ncpuro0201] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Accepted: 05/10/2005] [Indexed: 12/24/2022]
Abstract
Peyronie's disease (PD) is characterized by fibrotic plaques in the penile tunica albuginea that cause curvature of the erect penis, and is often accompanied by pain and/or erectile dysfunction. This condition affects up to 9% of men. Treatment is mainly surgical, as pharmacologic therapy has limited efficacy. The pathophysiology of PD is poorly understood, but development of two rat models, extrapolation of what is known about the molecular pathology of other fibrotic conditions, and emphasis on the role of myofibroblasts and adult stem cells are helping to clarify etiology and identify new pharmacologic targets. Recent studies demonstrate a role for oxidative stress and cytokine release-primarily transforming-growth-factor beta1-in development of PD fibrotic plaques. There is evidence indicating that these profibrotic factors interact with antifibrotic defense mechanisms, such as decrease of myofibroblast accumulation, elimination of reactive oxygen species by inducible nitric oxide synthase and neutralization of transforming-growth-factor beta1 by decorin, such that some plaques are in dynamic turnover. Injury to the erect penis is thought to trigger PD by inducing extravasation of fibrin and subsequent synthesis of transforming-growth-factor beta1. Despite the lack of statistical support for a causal association between trauma and PD, it is possible that undetected microtrauma is involved. It is not known whether ossification of PD plaques is linked to fibrosis progression or is a manifestation of an alternative pathway. Both processes seem to be related to activation of fibroblast/myofibroblast differentiation in the tunica albuginea and to osteogenic commitment of stem cells in this tissue.
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Bulstrode NW, Mudera V, McGrouther DA, Grobbelaar AO, Cambrey AD. 5-fluorouracil selectively inhibits collagen synthesis. Plast Reconstr Surg 2006; 116:209-21; discussion 222-3. [PMID: 15988270 DOI: 10.1097/01.prs.0000169701.16509.d6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fibroproliferative disorders, such as Dupuytren's contracture of the hand, are characterized by excessive production of collagen. 5-Fluorouracil has been used to treat fibroproliferative disorders of the eye and skin and is thought to inhibit thymidylate synthetase blocking DNA replication. 5-Fluorouracil has been shown to down-regulate fibroblast proliferation and differentiation in vitro. METHODS This study investigated the dose-dependent effect of 5-fluorouracil on fibroblast extracellular matrix production. Fibroblasts were derived from tendon and primary Dupuytren's disease of the hand, a fibroproliferative disorder of the palmar aponeurosis (n = 4 patients). Total collagen synthesis was determined by means of the incorporation of radiolabeled proline. Fibroblast secretion of the profibrotic factor transforming growth factor-beta1 (TGF-beta1) was measured by a sandwich enzyme-linked immunosorbent assay. Gene expression of collagen types I and III and TGF-beta1 were quantified by means of reverse-transcriptase polymerase chain reaction assays. RESULTS The authors found that 5-fluorouracil caused a dose-dependent, selective, and specific decrease in collagen production by Dupuytren's fibroblasts compared with noncollagenous protein synthesis. By contrast, procollagen types I and III mRNA were unaffected by 5-fluorouracil treatment. These changes did not appear to be mediated by alterations in the endogenous secretion of TGF-beta1 or its autocrine effect on collagen metabolism. CONCLUSIONS The clinical implication is that 5-fluorouracil could possibly reduce extracellular matrix production and therefore reduce recurrence of Dupuytren's disease of the hand.
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Affiliation(s)
- Neil W Bulstrode
- RAFT Institute of Plastic Surgery, Mount Vernon Hospital, Middlesex, United Kingdom
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Forsman M, Kallioinen L, Kallioinen M, Ryhänen J. Dupuytren's contracture; increased cellularity--proliferation, is there equality? Scand J Surg 2005; 94:71-5. [PMID: 15865122 DOI: 10.1177/145749690509400117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dupuytren's disease is a chronic inflammatory process which causes contractures of the fingers by shortening and thickening the palmar fascia. During the proliferative phase, fibroblasts transform into myofibroblasts apparently under the influence of several different factors. The disease usually develops slowly, but in some patients it tends to develop aggressively. The pathogenesis of Dupuytren's disease remains unsolved. In this study, we analyzed some histological characteristics that seem to predict rapid recurrence. MATERIAL AND METHODS 21 patients were divided into two groups. In 11 patients the disease was classified as aggressive because it had recurred within two years after an operation. In 10 cases it was non-aggressive, as no recurrence had been seen. Five control samples were taken from healthy palmar aponeurosis. The differences in cellularity, collagen, Ki-67, MSA, alpha-SMA and tenascin between the specimens were analyzed using immunohistochemistry. RESULTS Alpha-SMA and Ki-67 were present more often in the aggressive specimens. Immunohistochemical stainings for macrophages and lymphocytes were negative. CONCLUSION There may be differences in the histology and/or immunohistochemical appearance of pathological palmar connective tissue cords in aggressive and normal Dupuytren's disease. Further studies are needed to elucidate the pathogenesis of this disease.
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Affiliation(s)
- M Forsman
- Department of Surgery, Oulu University Hospital, Finland.
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Ehrmantant WR, Graham WP, Towfighi J, Mackay DR, Ehrlich HP. A histological and anatomical profile of pacinian corpuscles from Dupuytren's contracture and the expression of nerve growth factor receptor. Plast Reconstr Surg 2005; 114:721-7. [PMID: 15318052 DOI: 10.1097/01.prs.0000131017.15574.a9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The etiology of Dupuytren's disease is unknown. The causes of the fibroplastic response of nodules, fibrosis of cords, and prominence of pacinian corpuscles are not evident. Histological and immunohistology differences in pacinian corpuscles from the hands of five patients with Dupuytren's disease compared with 17 Dupuytren's-free patients are presented. Histological sections of pacinian corpuscle specimens were stained with hematoxylin and eosin and immunostained for nerve growth factor receptor. The length and width of intact pacinian corpuscles were measured, and the number of layers within each corpuscle was counted and recorded. Grossly, the pacinian corpuscles from Dupuytren's patients were larger and more numerous compared with those from unaffected patients. When measured microscopically, the pacinian corpuscles from Dupuytren's diseased fascia were significantly larger (2.0 x 1.1 mm) compared with controls (1.5 x 0.78 mm). The pacinian corpuscles from Dupuytren's-affected patients had significantly more layers (64 +/- 14) compared with those from control patients (40 +/- 9). Nerve growth factor receptor staining of pacinian corpuscles from patients affected with Dupuytren's disease showed greater intensity and more area stained compared with unaffected controls. It is suggested that nerve growth factor may be involved in the increased size of pacinian corpuscles in Dupuytren's-affected fascia. It is proposed that the cellular outgrowth from pacinian corpuscles may generate the cells that develop into Dupuytren's nodules.
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Affiliation(s)
- Wilfred R Ehrmantant
- Division of Plastic Surgery and the Department of Pathology, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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Qian A, Meals RA, Rajfer J, Gonzalez-Cadavid NF. Comparison of gene expression profiles between Peyronie's disease and Dupuytren's contracture. Urology 2005; 64:399-404. [PMID: 15302515 DOI: 10.1016/j.urology.2004.04.006] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2003] [Accepted: 04/07/2004] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To compare the gene expression alterations in human Peyronie's disease (PD) and Dupuytren's disease (DD) to determine whether they share a common pathophysiology. Multiple mRNA expression profiles of human PD have previously shown that genes that regulate fibroblast replication, myofibroblast differentiation, collagen metabolism, tissue repair, and ossification are involved. DD, a palmar fascia fibrosis, may be associated with PD. METHODS Total RNA samples from PD plaques, normal tunica albuginea, Dupuytren's nodules, and normal palmar fascia (nine samples per group) were subjected to differential gene expression profile analysis (Clontech Atlas DNA microarray) comparing PD with tunica albuginea and DD with normal palmar fascia. Changes of more than 2.0 in PD and DD compared with tunica albuginea and normal palmar fascia, respectively, were recorded. Reverse transcriptase-polymerase chain reactions were performed for some genes whose expression was altered in PD. RESULTS Some of the gene families upregulated in both PD and DD were (a) collagen degradation: matrix metalloproteinase (MMP), with MMP2 and MMP9, and thymosins (MMP activators), with TMbeta10 and TMbeta4; (b) ossification: osteoblast-specific factors (OSFs) OSF-1 and OSF-2 (DD only); and (c) myofibroblast differentiation: RhoGDP dissociation inhibitor 1. The genes upregulated in PD only were decorin (an inhibitor of transforming growth factor-beta1 and a part of fibroblast replication/collagen synthesis) and early growth response protein. Reverse transcriptase-polymerase chain reaction confirmed these changes. CONCLUSIONS These data demonstrate that the pattern of alterations in the expression of certain gene families in PD and DD is similar, suggesting that they share a common pathophysiology and may be amenable to the same therapeutic regimens.
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Affiliation(s)
- A Qian
- Harbor-UCLA Research and Education Institute, Torrance, California 90502, USA
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